Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.
Respir Care. 2024 Sep 26;69(10):1266-1274. doi: 10.4187/respcare.11603.
In 2021, the European Respiratory Society (ERS)/American Thoracic Society (ATS) guidelines issued a new definition of bronchodilator responsiveness, which is now defined as an increase in FEV or FVC by ≥ 10% of the predicted FEV or FVC. The impact of this revised definition on bronchodilator responsiveness prevalence has been relatively understudied.
We retrospectively analyzed data from 2,696 subjects who performed pulmonary function testing at the University of Iowa from 1997 to 2018. We compared the prevalence of bronchodilator responsiveness by using the 2005 (FEV or FVC increase ≥ 12% baseline value and ≥ 200 mL) and 2021 (FEV or FVC increase ≥ 200 mL and ≥ 12% of baseline value) ERS/ATS definitions, across several different respiratory diagnosis categories. We compared the prevalence of bronchodilator responsiveness using the 2 definitions by applying the McNemar test and assessed concordance of bronchodilator responsiveness by calculating kappa coefficients for the whole study population and within each diagnosis category.
The prevalence of bronchodilator responsiveness increased from 9% when using the 2005 ERS/ATS definition to 16% when using the 2021 definition within the entire cohort and also within each respiratory diagnosis category. In the subjects with normal pre-bronchodilator spirometry, there was a low prevalence of bronchodilator responsiveness (3%) when using the 2005 definition, and the prevalence increased (8%) when using the 2021 definition. In the subjects with normal pre-bronchodilator spirometry and FEV Z score ≥ 0, 2% had bronchodilator responsivness according to the 2005 guidelines, whereas 7% had bronchodilator responsiveness according to the 2021 guidelines.
The prevalence of bronchodilator responsiveness increased when using the new 2021 ERS/ATS definition compared with the 2005 definition. In the subjects with normal pre-bronchodilator spirometry, the prevalence of bronchodilator responsiveness increased when using the 2021 definition, in particular, among those with an FEV Z score ≥ 0, which raises concerns for overdiagnosis. Future investigations should examine the correlation of bronchodilator responsiveness with clinical outcomes in this group of subjects.
2021 年，欧洲呼吸学会（ERS）/美国胸科学会（ATS）发布了新的支气管扩张剂反应定义，现在定义为 FEV 或 FVC 增加≥预测 FEV 或 FVC 的 10%。这一修订定义对支气管扩张剂反应性的流行程度的影响相对研究较少。
我们回顾性分析了 1997 年至 2018 年在爱荷华大学进行肺功能测试的 2696 名受试者的数据。我们比较了使用 2005 年（FEV 或 FVC 增加≥12%基线值和≥200 mL）和 2021 年（FEV 或 FVC 增加≥200 mL 和≥基线值的 12%）ERS/ATS 定义的支气管扩张剂反应性的流行率，跨越了几个不同的呼吸诊断类别。我们通过应用 McNemar 检验比较了这两种定义下支气管扩张剂反应性的流行率，并为整个研究人群和每个诊断类别计算了kappa 系数来评估支气管扩张剂反应性的一致性。
在整个队列中，使用 2005 年 ERS/ATS 定义时，支气管扩张剂反应性的流行率为 9%，而使用 2021 年定义时为 16%。在支气管预扩张后肺功能正常的受试者中，使用 2005 年定义时支气管扩张剂反应性的流行率较低（3%），而使用 2021 年定义时流行率增加（8%）。在支气管预扩张后肺功能正常且 FEV Z 评分≥0 的受试者中，根据 2005 年指南，有 2%的人有支气管扩张剂反应性，而根据 2021 年指南，有 7%的人有支气管扩张剂反应性。
与 2005 年的定义相比，使用新的 2021 年 ERS/ATS 定义时，支气管扩张剂反应性的流行率增加。在支气管预扩张后肺功能正常的受试者中，使用 2021 年定义时，支气管扩张剂反应性的流行率增加，尤其是在 FEV Z 评分≥0 的受试者中，这引起了过度诊断的担忧。未来的研究应该在这组受试者中检查支气管扩张剂反应性与临床结果的相关性。
